Individual
DR. JESSE AIDEN MYTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
127 COLUMBIA AVE, VANDERGRIFT, PA 15690-1101
(724) 567-7520
(724) 568-2169
Mailing address
1601 UNION AVE, SUITE B, NATRONA HEIGHTS, PA 15065-2133
(724) 226-0544
(724) 226-2172
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC005745
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013170390001
—
PA
Enumeration date
11/29/2005
Last updated
12/17/2012
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